Provera & Clomid & Letrozole…Oh My!

When my husband and I got married in March 2010, we knew we wanted to start trying to get pregnant pretty soon after.  I already knew that there was a big chance we would have problems conceiving, and the fact that I hadn’t had a period in almost a year and half was not a good sign either.  I saw Dr. L a month before my wedding and told him I didn’t want to be put on the pill again because we were planning on TTC within the year.  So he gave me an Rx for Provera {medroxyprogesterone} with 3 refills to make myself have a period until we came back to see him again.

In October 2010 my husband and I went in for our first {of many} consultations together with Dr. L.  He explained to Hubby what was going on in my body and what we going to have to do to get pregnant.

First, I would take a 10 day dose of Provera to make me start my period.  Sounds easy enough, right? Sure. Except for the fact that Provera makes me an absolute CRAZY person.  And by crazy, I mean short tempered, hateful, and angry.  Think of the worst PMS you’ve ever had and times that by 10.  Yep.  That’s it.  Luckily, my first cycle of the meds didn’t really bother me too much.  The crazy ended up coming a little later on.  But I digress… So I took Provera for 10 days. Within another 5 days after my last dose, I started my period {cycle day 1}.  The day I started I began numbering the days on my calendar, days 1 through 35.  On days 5-9 of my cycle, I took 50mg of Clomid a day.  Clomid is an entirely different beast.  This medicine is supposed to stimulate my ovaries and produce ovulation.  It also makes me a blubbering whiny mess who cries all the time. ALL THE TIME.  After my last dose of Clomid, the Hubs and I were instructed to do it like rabbits at the very least every other day on cycle days 12-20 {possible ovulation days}.  Then on cycle day 22 I went back to the doctor to have labs drawn, for what Dr. L’s nurse calls my quant.  Basically, they are checking progesterone levels to see if I ovulated or not.

Ok, got all that?

So our first cycle on the meds we didn’t really have any big expectations.  Dr. L said he was starting me out on the lowest dose of Clomid to see if my body would respond to it or not and then we would go from there.  My day 22 quant levels came back very low at 2.7.  Nurse D told me that anything above 5 they consider that you ovulated but they like to see numbers at 10 or higher {since we’ve been doing this my quant levels have never been higher than 7}.  She told me I most likely did not ovulate this cycle.  So I probably wouldn’t start my period on my own, and if I hadn’t by cycle day 35 to take an HPT just to be sure and then we would start another cycle and up my dosage of Clomid up to 100mg.

Well, low and behold, right around Thanksgiving the HPT came back POSITIVE.  Positive! The hubs and I were estatic, but cautious, and maybe even a little scared.  We weren’t expecting to get pregnant so quickly.  Dr. L had me come in that day for a blood test.  My HCG level showed I was indeed pregnant, although it was so low that he wasn’t even sure how it showed up positive on a HPT {HCG levels usually have to be 25 or higher to get a positive urine test. Mine was around 20.}   For the next 2 weeks he had me coming in nearly every other weekday to have blood drawn.  In a normal pregnancy, the HCG levels will double every 48 hours.  Mine were going up, but they were not as high as they should be.  It was way too early to tell if anything was wrong, and we wouldn’t be able to see anything on an ultrasound until we were at least 6 weeks along.  When we finally tried an ultrasound, they still couldn’t see anything.   Dr. L told me that it may still be too early to see, but to prepare myself for the possibility of a miscarriage or an ectopic pregnancy since my HCG levels were not anywhere near what they should be.

He had me come back a week later for another ultrasound.  It was now the week of Christmas. This time they were able to see that it was an ectopic pregnancy {a pregnancy that happens outside of the uterus, in my case the fallopian tube}.  Since we caught it so quickly, Dr. L wanted to try treating it with medication before doing surgery.  I left work that day {December 21} to go to outpatient at the hospital where I was given two injections, one in each hip, of a drug so strong that I had to have my liver function checked before they gave it to me.  These injections were actually a form of chemo treatment, used to shrink tumors.  The idea is that they will shrink the pregnancy and it will expel itself.  This was the ideal way to go, because if it worked I would avoid surgery and possible trauma to my fallopian tube, which could cause another tubal pregnancy in the future.

Everything seemed to go fine with the injections.  The hubs and I were sad, but we had known from the very beginning that something was wrong, so we didn’t let ourselves get too emotionally attached to the pregnancy.  We had tried to act like I wasn’t even pregnant at all.  Don’t get me wrong, it was difficult and emotionally taxing.  But it helped to know from the get-go that something was wrong.  And to be honest, we were just happy to know that we actually COULD get pregnant.

My first day back to work after the New Year was January 4th.  It was a Tuesday, and a surgery day in the clinic that I work.  I felt fine that morning.  Everything was going well.  And then it hit me.  Literally, I was good one second and the next I was hunched over in the fetal position in incredible pain in the operating room floor.  Pain that I had never felt before.  Pain that felt like something was going to explode in my abdomen.  Within minutes I had tears streaming down my face because it hurt so bad.  I knew something was wrong.

Nurse D called me back immediately and instructed me to come in right then and there for an ultrasound.  Turns out the injections didn’t work and the pregnancy in my fallopian tube had continued to grow and was very much in danger of rupturing my fallopian tube {which could be fatal}.   Dr. L told me we could do surgery that evening or first thing the next morning.  I of course bursted into tears {again} when he told me I had to have surgery.  I opted for the morning.

That next morning in pre-op Dr. L visited with me and the hubs and told us he would do everything he could to save the tube.  The very first thing I asked after waking up was whether or not he took my tube.  Turns out, he did.  When he got in, it had already started to rupture and bleed on the underneath side {thats where all the pain and pressure was coming from}.  There was so much damage and trauma that he felt like it would do me more harm than good to leave it, because it would most definitely end up in another tubal pregnancy in the future.

So now, on top of the PCOS and ovulation problems, my chances of getting pregnant are automatically cut in half because I now only have one fallopian tube.

I had to wait 6 weeks after my surgery before we could start trying again.  It was almost March when I started my next Provera/Clomid cycle.  We ended up doing 4 cycles without any luck at all.  On the 5th cycle after my surgery, Dr. L told me if it didn’t work this time then he wanted me and the hubs to come in for another consultation on what we should try next.  My quant level was only 2.5 so we weren’t getting our hopes up.  But, by the first part of August we had another positive pregnacy test.

We were excited, but cautious.  Dr. L kept a close eye on me because of my history.  We did bloodwork 2-3 times a week for the first several weeks {I had more track marks than a heroine addict!}.  Thankfully, everything was looking great.  My HCG levels were doubling like crazy, I was tired and fatigued, I didn’t have an appetite at all and couldn’t stand the smell of chicken, and my boobs were incredibly sore.  All of these things made Dr. L very happy.  At around 5 weeks we were able to do our first ultrasound, and so far everything looked good.  I continued to do bloodwork once a week  until the next ultrasound at 7  1/2 weeks on Monday, September 19, where we got to hear our baby’s heartbeat.  It was incredible.  And healthy.  And it finally looked like things were going to happen for us.  Dr. L saw us that day and said everything looked perfect, he had no reason to worry and decided to only see me once a month from here on out instead of nearly once a week like we had been doing.  He did warn us that we were still in the very early stages, and most miscarriages happen within the first 12 weeks.  But again, everything looked great, so at that point there was no reason to worry.

That Friday, September 23, I started bleeding at work at around 3:45pm.  It was light bleeding, but definitely more than spotting.  I called Dr. L’s office and Nurse D called me back quickly, telling me to go ahead and come in for another ultrasound just to be safe.  I left work that day with barely a word to anyone and went straight to the doctor, which thankfully is  just across the street from the office I work.  It was Friday and well after 4 o’clock, and the office was empty except for the girl behind the desk, the ultrasound tech, Nurse D, and me.

I knew that something was wrong by the look on the ultrasound tech’s face.  She was trying hard to void her face of any emotion, but I saw it.  She told me sweetly that I could get dressed and she would be right back.  Nurse D was the one who returned and asked me to follow her to an exam room.  The office was literally deserted and most of the hallways were dark.  I felt bad for keeping them here so late.   When we got to the room she broke the news to me.  There was no heartbeat.  I was miscarrying.  It looked like it had just happened.  I had feared this was what was happening as soon as I started bleeding, but as soon as she said the words I broke down.

Nurse D told me Dr. L had left the office at 2 that day, and there was another doctor on call who could come in and talk to me.  I told her that was fine.  But Nurse D said she was going to call Dr. L first because she felt like he would really want to know.  I didn’t want to bother him at home, but she insisted and stepped out to call him.  Within a few minutes she came back in and told me not to go anywhere, he was on his way.

Dr. L showed up 15 minutes later in jeans and an old t-shirt.  He had been working outside in his yard he told me.  Dr. L had taken a special interest in me, and when he heard what had happened he wanted to be the one to come in and see me.  I can’t even begin to describe how much that meant to me.

I was 8 weeks and 1 day along when my baby’s heart stopped beating.  He basically told me that when miscarriages happen this early, its hard to find a reason why.  Usually there is some defect in either the egg or the sperm that causes the baby to stop developing at some point.  He insisted there was nothing we could’ve done to prevent or cause it.  If it was going to happen, it was going to happen.

Dr. L gave me the choice of doing a D&C or letting it happen naturally at home.  I wanted to avoid another surgery at all cost {not only because I didn’t want to be put under again, but because of my past experience working in surgery, I know exactly what happens during a D&C. no, thank you.}, so I chose to let it happen at home.  He told me that if I could handle it, that was the way to go.  Especially since we wanted to start trying again as soon as we could, and the D&C causes a lot of trauma to the uterus.

I couldn’t get through to the hubs at work so I had to break the news when he got home.  He punched walls.  I cried.

The next week was probably the hardest of my life.  Physically and emotionally.  I had no idea the kind of pain I would experience.  I was almost in shock about it.  Nurse D told me I was essentially having contractions.  So I spent most of the week in bed with my heating pad and a bottle of Lortab.  In the few moments I was spared of pain, all I did was cry.  I can’t even really describe what I was going through mentally.  Its not something that you can really understand unless you’ve been through it yourself.  The most horrible thing was that I still felt pregnant, even though I knew the baby was gone.

For the next few months I cried, if only a little bit, every single day.  Every. Single. Day.  Its coming up on a year now and I still often cry about it.  I don’t think its something that I will ever completely get over.

In December we got to start trying again.  We started back on our old regimen of Provera and Clomid.  Dr. L wanted to give it a few more shots since we had successfully gotten pregnant on it before.  He bumped my dosage up to 150mg and for 4 cycles it was hit and miss.  I either didn’t ovulate at all or I did and didn’t get pregnant {which is possibly because I was ovulating from my left ovary, the side that doesn’t have a fallopian tube}.  In May we were surprised again with another positive HPT.  Then, the next day I started my period.  It ended up being what is called a chemical pregnancy.  The egg was fertilized, but it just didn’t implant, so I had my period like normal.  There was enough HCG in my blood to get a positive pregnancy test, and since I take 20 HPT’s a cycle, of course it showed up.  A normal woman probably wouldn’t have even known because she would’ve just had her period like normal.

After this, Dr. L brought us in and decided we were going to try something new.  He put me on birth control for 1 month to “quiet” my ovaries down so we could essentially start from scratch.  When I started my next cycle, instead of Clomid I was to take 2.5mg of a new medication called Letrozole {Femara}.  This is actually a breast cancer medication but is apparently being used to stimulate ovulation as well.  Its been known to work well in women who don’t respond to Clomid.

So on cycle days 5-9 this month, I took Letrozole instead of Clomid {it also made me cry unconrtollably}.  On day twelve of my cycle Dr. L had me come in for an ultrasound to check and see if I had any follicles on my ovaries.  We got good news: there were good follicles on my right ovary and they were the perfect size he said.  He wanted me get what he called a trigger shot {Pregnyl to trigger ovulation} on Thursday and then come in Friday morning to do IUI {Intrauterine Insemination}.  Dr. L felt that since our chances are pretty much cut in half from the get go, IUI would increase our chance of getting pregnant, because we would be making sure the sperm got to the egg.

So yesterday {Friday, July 20} I went in for my IUI.  I took the rest of the day off work because I was feeling a little crampy for most of the day afterwards.  It was actually pretty easy and everything went well.  I only felt a little discomfort during the IUI, and honestly that was nothing compared to what I’ve been through thus far.

Now its time for the big TWW {two week wait}.  Yes, I still won’t know for another two weeks if the IUI worked or not — same as if I got knocked up the old fashioned way.  I’ve very nervous and excited and just so hopeful that it works.

I feel like I’m due for some good luck.

Advertisements